FPPA Statewide Death & Disability Plan Forms

For Members During Their Career

Step by Step Through the Disability Process

Apply for a Disability Benefit


For Member Survivors

Apply for a Survivor Benefit


For Members Currently Receiving Benefits

Change in Disability Status Application

Request SRA Distribution from FPPA - For the disability or survivor benefits applicable to your situation.
- Instructions
- Special Tax Notice
- Application

Currently receiving Disability Benefits and are now divorcing.

Disability Retiree Change of Designated Beneficiary


FPPA Forms for the Management of Deposits

Electronic Funds Transfer (EFT) Form

Deposit Advice Selection Form - Control the frequency of your Deposit Advices with this form. Learn more about Deposit Advices options.

Affidavit For Check Replacement

W-4P Monthly Pension Distribution Form

W-9 Request for Taxpayer Identification Number and Certification